| Baker Family Practice | |
|
1880 John Adams Pkwy Idaho Falls ID 83401-4315 | |
| (208) 524-6633 | |
| (208) 524-9952 |
| Full Name | Baker Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1880 John Adams Pkwy, Idaho Falls, Idaho |
| Authorized Official Name and Position | Wallace C. Baker (DOCTOR) |
| Authorized Official Contact | 2085246633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baker Family Practice 1880 John Adams Pkwy Idaho Falls ID 83401-4315 Ph: (208) 524-6633 | Baker Family Practice 1880 John Adams Pkwy Idaho Falls ID 83401-4315 Ph: (208) 524-6633 |
| NPI Number | 1134140148 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 07/19/2010 |
| Medicare PECOS PAC ID | 0446208904 |
|---|---|
| Medicare Enrollment ID | O20050111000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134140148 | NPI | - | NPPES |
| 1083696967 | Other | ID | IND NPI NUMBER |
| 807937700 | Medicaid | ID | |
| D1614 | Other | ID | RAILROAD MCR GROUP |
| 8K123 | Other | ID | GRP BLUECROSS NO. |
| 000010027582 | Other | ID | BLUE SHIELD GROUP NUMBER |
| 72132 | Other | ID | BLUECROSS NUMBER |
| 000010001770 | Other | ID | BLUE SHILD INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M6919 (Idaho) | Primary |
| Provider Name | Wallace Coleman Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083696967 PECOS PAC ID: 6608824164 Enrollment ID: I20100823001005 |
| Provider Name | Jessica Lynne Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457913162 PECOS PAC ID: 0446683577 Enrollment ID: I20191204001273 |
| Provider Name | Danae Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619659968 PECOS PAC ID: 8426403809 Enrollment ID: I20231005001519 |
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